Academic literature on the topic 'Exercise-based lifestyle interventions'

GlycA is a new composite measure of systemic inflammation and a predictor of many inflammatory diseases. GlycA is the nuclear magnetic resonance spectroscopy-derived signal arising from glucosamine residues on acute-phase proteins. This study aimed to evaluate how exercise-based lifestyle interventions modulate GlycA in persons at risk for type 2 diabetes. GlycA, fitness, and body habitus were measured in 169 sedentary adults (45–75 years) with prediabetes randomly assigned to one of four six-month exercise-based lifestyle interventions. Interventions included exercise prescription based on the amount (energy expenditure (kcal/kg weight/week (KKW)) and intensity (%VO2peak). The groups were (1) low-amount/moderate-intensity (10KKW/50%) exercise; (2) high-amount/moderate-intensity (16KKW/50%) exercise; (3) high-amount/vigorous-intensity (16KKW/75%) exercise; and (4) a Clinical Lifestyle (combined diet plus low-amount/moderate-intensity exercise) intervention. Six months of exercise training and/or diet-reduced GlycA (mean Δ: −6.8 ± 29.2 μmol/L;p=0.006) and increased VO2peak(mean Δ: 1.98 ± 2.6 mL/kg/min;p<0.001). Further, visceral (mean Δ: −21.1 ± 36.6 cm2) and subcutaneous fat (mean Δ: −24.3 ± 41.0 cm2) were reduced, while liver density (mean Δ: +2.3 ± 6.5HU) increased, allp<0.001. When including individuals in all four interventions, GlycA reductions were associated with reductions in visceral adiposity (p<0.03). Exercise-based lifestyle interventions reduced GlycA concentrations through mechanisms related to exercise-induced modulations of visceral adiposity. This trial is registered with Clinical Trial Registration Number NCT00962962.

Background Exercise and a healthy diet can improve the quality of life and prognosis of prostate cancer survivors, but there have been limited studies on the feasibility of web-based lifestyle interventions in this population. Objective This study aims to develop a data-driven grounded theory of web-based engagement by prostate cancer survivors based on their experience in the Community of Wellness, a 12-week randomized clinical trial designed to support healthy diet and exercise habits. Methods TrueNTH’s Community of Wellness was a four-arm pilot study of men with prostate cancer (N=202) who received progressive levels of behavioral support (level 1: website; level 2: website with individualized diet and exercise recommendations; level 3: website with individualized diet and exercise recommendations, Fitbit, and text messages; and level 4: website with individualized diet and exercise recommendations, Fitbit and text messages, and separate phone calls with an exercise trainer and a registered dietitian). The primary aim of the study is to determine the feasibility and estimate the effects on behaviors (results reported in a separate paper). Following the 12-week intervention, we invited participants to participate in 4 focus groups, one for each intervention level. In this report, we used grounded theory analyses including open, axial, and selective coding to generate codes and themes from the focus group transcripts. Categories were refined across levels using embodied categorization and constant comparative methods. Results In total, 20 men with prostate cancer participated in the focus groups: 5, 4, 5, and 6 men in levels 1, 2, 3, and 4, respectively. Participants converged on 5 common factors influencing engagement with the intervention: environment (home environment, competing priorities, and other lifestyle programs), motivation (accountability and discordance experienced within the health care system), preparedness (technology literacy, health literacy, trust, and readiness to change), program design (communication, materials, and customization), and program support (education, ally, and community). Each of these factors influenced the survivors’ long-term impressions and habits. We proposed a grounded theory associating these constructs to describe the components contributing to the intuitiveness of a web-based lifestyle intervention. Conclusions These analyses suggest that web-based lifestyle interventions are more intuitive when we optimize participants’ technology and health literacy; tailor interface design, content, and feedback; and leverage key motivators (ie, health care providers, family members, web-based coach) and environmental factors (ie, familiarity with other lifestyle programs). Together, these grounded theory–based efforts may improve engagement with web-based interventions designed to support prostate cancer survivorship.

The purpose of this study was to examine the effects of a long-term community-based lifestyle intervention on the biochemical indicators and prevalence of metabolic syndrome among elderly adults. This was a randomized controlled trial in northern Taiwan from August 2013 to February 2015. Sixty-nine elderly adults participated in this study. There were three measurements. The experimental group participated in exercise and diet interventions. The control group participated in the exercise intervention. Repeated measurement and ANCOVA were performed to evaluate the effectiveness. After 18 months, body weight (1.06 kg), body mass index (1.21 kg/m2), waist circumference (3.32 cm), blood pressure, and prevalence (30.4%) of metabolic syndrome were significantly reduced in all subjects. There were significant differences in waist circumference and high-density lipoprotein cholesterol between the two groups. This intervention can lower the indicators and prevalence of metabolic syndrome. Exercise and diet interventions could promote further metabolic changes.

AbstractCardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient’s priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The ‘dose’ of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.

Abstract Objectives To establish the preferences and perceived barriers related to physical activity and diet programming of breast cancer survivors (BCS) to inform the development of Information and Communication Technology (ICT)-based lifestyle interventions. Methods This was a cross-sectional study of 197 BSC aged 18 years or older and diagnosed with ductal carcinoma in situ (DCIS) or Stage I-IV breast cancer. The BCS were recruited during routine oncology appointments at a Midwestern cancer center. A survey was conducted to query survivors’ level of interest in, preferences for, and perceived barriers to participating in an exercise and dietary intervention program, with a specific emphasis on ICT-based programming. Results Overall, 85% of BCS reported they would consider participating in exercise and diet intervention research. Approximately 45% of participants reported that they had received diet and/or exercise information as part of their cancer care. However, only 15% of the participants received such information from healthcare professionals with the appropriate expertise (e.g., Dietitian, Exercise Specialist). Over two-thirds of the participants reported frequent use of mobile devices and the internet, and 80% indicated comfort using these devices (e.g., tablet, smart phone). The top three preferred formats for an ICT-based diet and exercise intervention program were “website”, “mobile apps” and “e-mails”. Older participants (&gt;60 years) were more likely to report a preference for e-mails while younger participants (&lt;60 years) were more likely to report a preference for websites or mobile apps. The most common perceived barriers to participation in a lifestyle intervention included fatigue, family responsibility and work. Conclusions Most BCS in this study were interested in exercise and diet interventions and would be comfortable with an ICT-based format with a preference for delivery via websites, mobile apps or e-mails. Future ICT-based lifestyle interventions should be designed with consideration of BCS’ age, barriers, facilitators and other characteristics. Funding Sources USDA-NIFA Hatch Project 1,011,487

Abstract Purpose The aim of this review is to systematically review randomized controlled trials on lifestyle interventions on PCa patients undergoing androgen deprivation therapy. Methods A literature search was conducted using the electronic databases Medline and PubMed. To be eligible, studies had to be randomized controlled trials (RCTs) that focused on side effects of ADT and lifestyle interventions to reduce side effects for men undergoing ADT with PCa. Lifestyle interventions were defined as interventions that included any dietary or behavioral components. Results Twenty-nine trials were included. Most of them focused on exercise interventions, while some investigated the effect of dietary or behavioral interventions. The effect of different lifestyle influencing modalities aimed to improve on the adverse effects of ADT varied greatly. Conclusions It is not possible to draw one conclusion on the effect of exercise-based interventions, but noted on several adverse effects of ADT improvement. Further studies are necessary to develop personalized lifestyle interventions in order to mitigate the adverse effects.

AbstractAlzheimer’s disease (AD) is the most common neurodegenerative disease that leads to significant morbidities in elderly. The major pathological hallmark of AD is beta-amyloid plaques (Aβ) and intracellular neurofibrillary tangles (NFTs) deposition in hippocampus of the brain. These abnormal protein deposition damages neuronal cells resulting in neurodegeneration and cognitive decline. As a result of limited treatment options available for this disease, there is huge economic burden for patients and social health care system. Thus, alternative approaches (lifestyle intervention) to prevent this disease are extremely important. In this systemic review, we summarized epidemiological evidence of lifestyle intervention and the mechanisms involved in delaying and/or preventing AD. Lifestyle interventions include education, social engagement and cognitive stimulation, smoking, exercise, depression and psychological stress, cerebrovascular disease (CVD), hypertension (HTN), dyslipidaemia, diabetes mellitus (DM), obesity and diet. The methods are based on a literature review of available sources found on the research topic in four acknowledged databases: Web of Science, Scopus, Medline and PubMed. Results of the identified original studies revealed that lifestyle interventions have significant effects and our conclusion is that combination of early lifestyle interventions can decrease the risk of developing AD.

Exercise and physical therapies are increasingly being considered as a lifestyle intervention in people with Huntington's disease (HD). In addition to possible effects on motor function, there may be benefits in mood, behaviour and cognition from early in the disease. Certainly exercise may also infer general health benefits and there are recent suggestions that exercise may indeed potentiate disease modification. This review provides an overview of a strategic approach to the development and evaluation of complex exercise interventions in this neurodegenerative disease with a view to informing future clinical trials.

Androgen-deprivation therapy (ADT) is a systemic therapy administered for the management of advanced prostate cancer (PCa). Although ADT may improve survival, long-term use reduces bone mass density (BMD), posing an increased risk of fracture. Considering the long natural history of PCa, it is essential to preserve bone health and quality-of-life in patients on long-term ADT. As an alternative to pharmacological interventions targeted at preserving BMD, current evidence recommends lifestyle modifications, including individualized exercise and nutritional interventions. Exercise interventions include resistance training, aerobic exercise, and weight-bearing impact exercise, and have shown efficacy in preserving BMD. At the same time, it is important to take into account that PCa is a progressive and debilitating disease in which a substantial proportion of patients on long-term ADT are older individuals who harbor axial bone metastases. Smoking cessation and limited alcohol consumption are commonly recommended lifestyle measures in patients receiving ADT. Contemporary guidelines regarding lifestyle modifications vary by country, organization, and expert opinion. This comprehensive review will provide an evidence-based, updated summary of lifestyle interventions that could be implemented to preserve bone health and maintain quality-of-life throughout the disease course of PCa.

Supervised exercise training has substantial benefits for persons with multiple sclerosis (MS), yet 80% of those with MS do not meet recommended levels of moderate-to-vigorous physical activity (MVPA). This same problem persisted for decades in the general population of adults and prompted a paradigm shift away from “exercise training for fitness” toward “physical activity for health.” The paradigm shift reflects a public health approach of promoting lifestyle physical activity through behavioral interventions that teach people the skills, techniques, and strategies based on established theories for modifying and self-regulating health behaviors. This paper describes: (a) the definitions of and difference between structured exercise training and lifestyle physical activity; (b) the importance and potential impact of the paradigm shift; (c) consequences of lifestyle physical activity in MS; and (d) behavioral interventions for changing lifestyle physical activity in MS. The paper introduces the “new kid on the MS block” with the hope that lifestyle physical activity might become an accepted partner alongside exercise training for inclusion in comprehensive MS care.

Three studies were designed to investigate the effects of exercise-based lifestyle interventions including diet change and exercise training on cardiovascular and autonomic responses to various physical and mental challenges in untrained premenopausal women. In Study 1, the effects of different tasks designed to activate the sympathetic nervous system on autonomic control of cardiovascular functioning such as the Stroop colour-word task (Stroop) and lower body negative pressure (LBNP) in 20 untrained premenopausal women (22.6??0.7 years) were determined. In Study 2, a longitudinal exercise intervention strategy was used with 18 untrained premenopausal women (22.5??0.7 years) in order to investigate the effect of 15 weeks of high intensity intermittent exercise (HIIE) training on cardiac autonomic responses to mental challenge (Stroop) and LBNP. In Study 3, the effects of HIIE training combined with a Mediterranean-style eating plan and fish oil supplement (Fish oil, Exercise, Mediterranean diet; FEM) on cardiovascular function during mental challenge (Stroop) and physical tasks (handgrip and reactive hyperaemia) were examined in 32 overweight untrained premenopausal women (22.0??0.6 years). In these studies, forearm blood flow (FBF) was assessed using Hokanson Plethysmography with the venous occlusion technique. The surface electrocardiogram and continuous beat-to-beat arterial blood pressure were also monitored. Peak oxygen uptake was assessed using open-circuit spirometry (True Max 2400, ParvoMedics). In addition, body composition was measured using DEXA (dual energy X-ray absorptiometry; DPX-IQ, Lunar Radiation). Results from Study 1 indicate that FBF response to mental challenge in young females was smaller compared to previously obtained data from age-matched males. Furthermore, this FBF response to mental challenge was negatively correlated to insulin resistance estimated by the homeostasis model assessment (HOMA-IR) (r = - .52, p < .05). In addition, when cardiopulmonary baroreceptors were unloaded by a mild level of LBNP (-20 mmHg) during Stoop, FBF response to mental challenge (vasodilation) was abolished suggesting a large dependency of vasodilation response during mental challenge on cardiopulmonary baroreflex. After 15 weeks of supervised HIIE training, aerobic fitness improved (p < .05) whereas percent of body fat was significantly decreased (p < .05). In addition, recovery BP following Stroop was significantly reduced. Insulin resistance (HOMA-IR) was marginally decreased (p = .056). Women who had higher insulin resistance (HOMA-IR) lost less fat than women with lower HOMA-IR (r = .60, p = .088). In addition, change in FBF during Stroop after training was directly related to pretest insulin resistance levels (r = .68, p < .05). Therefore, HIIE training had a normalising effect on FBF response to mental challenge. PEP/LVET ratio at rest and during LBNP was also significantly increased in women with higher HOMA-IR suggesting a reduction in cardiac contractility via a decrease in sympathetic stimulation (r = .62, p = .076, r = .62, p = .75 respectively). In Study 3 results indicated that 12 weeks of the FEM trial significantly reduced percent of body fat (p < .001), fasting insulin (p < .05), interleukin-6 (p < .05) and cortisol (p < .05), and significantly improved aerobic fitness ( ; p < .001). With respect to cardiovascular and cardiac autonomic measures, rate pressure product (RPP) was significantly reduced at rest (p < .05) and during recovery after Stoop (p < .05), suggesting decreased myocardial oxygen consumption. In addition, baseline heart rate determined in the sitting position was significantly reduced (p < .05), while both baseline high frequency power (HF) determined in supine (p < .01) and cardiac baroreflex sensitivity (BRS) determined in the sitting position (p < .05) were increased after the FEM trial. In addition, BRS determined during mental challenge also marginally increased (p = .051). In summary, lifestyle intervention including HIIE training, Mediterranean-style eating plan, and a fish oil supplement significantly enhanced parasympathetic influence of the heart and improved fitness, blood profiles, and body composition.

[spa] ANTECEDENTES: Las intervenciones psicológicas de baja intensidad aplicadas mediante tecnologías de la información y la comunicación (TICs) constituyen una alternativa terapéutica eficaz y coste-efectiva en el tratamiento de la depresión. OBJETIVO: Evaluar la eficacia en Atención Primaria de una intervención de baja intensidad de estilo de vida saludable aplicada a través de TICs que ha mostrado previamente mejoras significativas en el tratamiento de la depresión leve y moderada en contextos clínicos especializados. MÉTODO: Ensayo clínico pragmático multicéntrico aleatorizado en 2 grupos paralelos. Se diseñó la intervención y se adaptó a dispositivos online y posteriormente se realizó el ensayo clínico controlado aleatorizado; se estudió a una muestra de N=120 pacientes con depresión leve a moderada reclutados en AP. Se les asignó aleatoriamente a a) programa psicoeducativo de estilo de vida saludable + Tratamiento Habitual mejorado (Improved Treatment As Usual, ITAU) o b) ITAU. El formato de las intervenciones fue de 1 sesión presencial y 4 módulos online. El diagnóstico de depresión se realizó con la entrevista psiquiátrica MINI. La variable principal de resultado fue la puntuación en el PHQ-9. También se administró el PANAS, (escala de afecto Positivo y Negativo), EuroQol (calidad de vida) y SF-12 Health Survey (estado de salud percibido). Los pacientes fueron evaluados en el momento basal, post, a los 6 y 12 meses post-tratamiento. Se realizó un análisis por protocolo y otro análisis por intención de tratar. RESULTADO: Valoramos la posible inclusión de 120 pacientes que estarían asignados aleatoriamente a una de las dos ramas de este estudio (estilo de vida vs. ITAU). Fueron reclutados 111. Se asignaron de forma aleatoria 54 pacientes (48.6% de la muestra) al grupo de estilo de vida y 57 al grupo control (51.4%). Incluimos únicamente quienes accedieron al programa y completaron los cuestionarios; 46 y 27 participantes respectivamente (65.77% del total). Tras acabar el tratamiento, continuaron en el estudio 58 de los 73 (79.46%). A los 6 meses eran 49 (67.1%), concluyendo el estudio a los 12 meses 46 participantes (63.02%). El perfil de la muestra fue de mujer (71.23% de casos) con una edad media de 45 años (desviación estándar 11.21), casada o emparejada (52.1%), viviendo en domicilio propio con su pareja y/o sus hijos (39.7%), con estudios secundarios completados (31.5%) y situación laboral de empleada (42.5%). Únicamente existió diferencia estadísticamente significativa en el estado civil. En el análisis por protocolo únicamente se obtuvieron diferencias estadísticamente significativas entre ambos grupos en el PHQ-9 tras concluir el estudio (p= 0,012). En el análisis por intención de tratar se obtuvo diferencia estadísticamente significativa tras concluir el estudio en el PHQ-9 (p=0,00), PANAS afecto negativo (p=0,049) y en el SF-12 componente físico (p=0,029), no encontrando diferencias estadísticamente significativas transcurridos 6 y 12 meses. DISCUSION: Una aportación relevante hallada en el análisis es que, al existir mejoría clínica de los síntomas depresivos tras acabar la intervención, conseguimos acelerar el proceso de recuperación en relación al grupo control. Este hallazgo implicaría disminuir el notable impacto en la calidad de vida del paciente y de su entorno, así como el coste económico al reducir su productividad y actividad laboral. Sin embargo, no se puede obviar que una de las mayores dificultades para vincularse a la intervención en estos pacientes es la sintomatología que presentan. Por eso parece fundamental seguir motivándoles para que sean constantes en el cambio y reciban un feedback positivo que puede realizarse a través de los auto-registros o disponer de apoyo social, algo de lo que nuestro estudio carece. El estudio presenta varias limitaciones: mejora solo a corto plazo, escaso tamaño de la muestra estudiada, elevada tasa de abandonos y ausencia de registro de situación basal del paciente en relación a su estilo de vida, así como de qué forma ésta se ha podido implantar a lo largo del tiempo. CONCLUSIONES: Realizar una intervención de baja intensidad sobre el estilo de vida saludable a través de las TICs mejora más rápidamente los síntomas depresivos, disminuye el afecto negativo y acelera la mejora el estado de salud percibido al acabar la intervención. Sin embargo, la diferencia en la disminución de la sintomatología depresiva entre el grupo de intervención y el grupo control no se ha mantenido en el tiempo. Será necesario considerar para futuras investigaciones cómo favorecer la adherencia al tratamiento y disminuir la tasa de abandonos para poder beneficiar a un mayor número de pacientes.
[eng] BACKGROUND: Low intensity psychological interventions applied through information and communication technologies (ICTs) are an effective and cost-effective therapeutic alternative in the treatment of depression. OBJECTIVE: To evaluate the efficacy in Primary Care of a low intensity intervention of healthy lifestyle applied through ICTs that has previously shown significant improvements in the treatment of mild and moderate depression in specialized clinical contexts. METHOD: Multicentric pragmatic randomized clinical trial in 2 parallel groups: a) healthy lifestyle + Improved Habitual Treatment (ITAU) or b) ITAU. The intervention was designed and adapted to be online and then the randomized controlled clinical trial was carried out. A sample of N = 120 patients with mild to moderate depression was recruited in Primary Care Settings. The diagnosis of depression was made with the MINI psychiatric interview. The main outcome variable was the score on the PHQ-9. PANAS was also administered (Positive and Negative Affect Schedule), EuroQol (quality of life) and SF-12 Health Survey (perceived health status). The patients were evaluated at baseline, post, at 6 and 12 months after treatment finished. An analysis by protocol and another analysis by intent to treat was performed. RESULTS: A total of 111 patients were recruited and randomly assigned to one of the two branches of this study. We include only those who accessed the program and completed the questionnaire. In the analysis by protocol, only statistically significant differences were obtained between both groups in the PHQ-9 after concluding the study (p = 0.012). In the intention-to-treat analysis, a statistically significant difference was obtained after concluding the study in the PHQ-9 (p = 0.00), PANAS negative affect (p = 0.049) and in the SF-12 physical component (p = 0.029), finding no statistically significant differences after 6 and 12 months. CONCLUSIONS: Performing a low intensity intervention on healthy lifestyle through ICTs improves the symptoms of depression more quickly. However, this difference has not been maintained over time. It will be necessary to consider for future investigations how to improve the adherence to treatment and decrease the dropout rate in order to benefit a greater number of patients.

Background: Recent evidence suggests weight loss is not necessary to reduce obesity related co-morbidities. The principal finding within these reports is based on examination of group mean values. Accordingly, it is possible that within a given group, the subjects who failed to lose weight did not experience any health improvement, a finding masked by the exaggerated improvement in those who did lose weight. We sought to determine whether a gradient exists between the inter-individual change in bodyweight and corresponding changes in body composition and metabolic risk factors in response to minimal or no weight loss. Methods: Total adipose tissue (AT) and skeletal muscle (SM) were determined by magnetic resonance imaging (MRI) in 46 men and 42 women participating in lifestyle-based programs designed to reduce obesity and related metabolic risk factors. Visceral AT (VAT) and abdominal subcutaneous AT (ASAT) were calculated from a single image at the L4-L5 inter-vertebral space. Glucose uptake was calculated using a hyperinsulinemic-euglycemic clamp procedure. Blood pressure (BP) was determined using an electronic cuff or manually using standard procedures. Waist circumference (WC) was taken at the level of the last rib. Results: Bodyweight did not change in men or women (p>0.10). Collapsed across gender, with the exception of ASAT, SM, and systolic BP, all other anthropometric, body composition, and metabolic risk factor measures improved significantly following treatment (p<0.05). With few exceptions, regression analysis revealed that changes in bodyweight or WC were not associated with corresponding changes in body composition measures or metabolic risk factors (p>0.05). To further consider whether a gradient existed between weight change or WC change on body composition and metabolic risk factors, subjects were cross-classified according to their level of weight/waist change (tertiles) and their respective change in either body composition or metabolic risk factor. Neither weight nor WC change tertile was related to any body composition or metabolic risk factor in a gradient fashion (p>0.05). Conclusion: These findings reinforce and extend the observation that independent of gender, lifestyle-based interventions are associated with reductions in obesity and related metabolic risk factors despite minimal or no weight loss.
Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2009-09-29 13:18:27.916

碩士
國立臺北護理健康大學
護理研究所
106
Background:Coronary artery disease is the most common cardiovascular disease, and secondary prevention should be implemented for its prevention. Regular exercise is one of the secondary prevention measures that can reduce disease risk factors and improve related prognosis and is also an important issue for health promotion around the world. The Hualien-Taitung area is located in a long and narrow area. Medical centers are concentrated in the urban area, but there is a large population of elderly and people living in rural areas. The patients of coronary artery disease do not have enough rehabilitation exercises in those centers and cannot effectively improve the rehabilitation benefits. In response to the needs of the coronary artery disease population in Hualien-Taitung area, a home exercise program for interventional treatment of coronary artery disease is designed to explore whether the expected outcome can delay progression, improve exercise capacity, control risk factors, improve quality of life related to health and reduce re- hospitalization rate and mortality. Purpose: The purpose of this study is to investigate the effectiveness of interventions with Hualien-Taitung area Coronary Artery Disease Meter Home Program for 3 months to see whether it can improve clinical biochemical indicators and quality of healthy life, reduce fatigue and the numbers of unintended return visits and re- admissions. Method: This study used the Quasi-experimental design method to receive cases at a medical center in the east, and the patients receiving transcatheter intervention for coronary artery disease were the subjects of the study. The experimental group participated in Coronary Artery Disease Meter Home Study (CADHE) program. CADHE is a home-based cardiac rehabilitation exercise program, in which the experimental group received a three-month aerobic exercise of 5 times a week, 30 minutes each time and a total of 12 weeks. Brisk walking was designed as the exercise, while the control group received conventional coronary care and conventional exercise for cardiac rehabilitation. The research tool was a structured questionnaire containing demographic attributes and disease attributes, clinical biochemical indicators, Seattle Angina Questionnaire (SAQ), Fatigue Severity Scale (FSS), number of unexpected return visits and number of re-admissions. The data were collected at intervention after the first month, the second month, and the third month. Clinical biochemical indicators were tested with paired t test and analyzed with generalized estimating equation. Seattle Angina Questionnaire (SAQ) and Fatigue Severity Scale (FSS) were analyzed with generalized estimating equation; the numbers of unexpected return visits and readmissions were analyzed with Poisson regression analysis. Results:The number of people in the study was 86, with 40 in the experimental group and 46 in the control group. The average age of the study cases was 60.25 (SD=9.57) in the experimental group and 63.11 in the control group (SD=9.88). The demographic basic data of the experimental group and the control group were examined by independent sample t-test and chi-square test. The results showed that the experimental group and the control group had significant differences only in gender(X2=4.84, p=0.028), and the number of coronary artery occlusions (X2=9.14, p=0.010) and the administration of OHA drugs (X2=4.83, p=0.036) were significantly different. Clinical biochemical indicators: 3 months after the intervention of the sample t test, biochemical indicators of total cholesterol (TCH) and low-density lipoprotein cholesterol (LDL-C) (p=<0.001) values decreased, high-density lipoprotein (HDL-C) biochemical indicator increased (p=<0.049), and the generalized estimation equation showed no significant effect. 5 SAQ health-related aspects of healthy living quality: all achieved significant results (P < 0.001), except for angina stability (P<0.062) and satisfactory treatment (P<0.112) of the third month, others did not achieve significant results, so the continuation effect failed. Fatigue severity: fatigue decreased significantly at the end of the first month and the second month of exercise intervention (p=<0.001), and it continued to decrease for 3 months (p=< 0.004). (5) The numbers of unexpected number of return visits and re-admissions: There was a significant decrease in the number of unintended return visits and the number of re-admissions after exercise intervention. Conclusion: The results of this study confirmed that the CADHE intervention program can enable patients with coronary artery disease to perform cardiac rehabilitation exercises at home in addition to the exercises at rehabilitation centers. The intervention can improve some biochemical indicators of patients and the quality of healthy life. It can significantly improve and reduce fatigue, reduce the numbers of unplanned return visits and readmissions, improve exercise capacity, delay disease progression, control risk factors and improve the quality related to healthy living.

In addition to theory testing, researchers have also examined if exercise interventions serve to enhance psychological constructs such as self-esteem and behavior such as functional fitness, activities of daily living (ADL), and physical activity. The purpose of this chapter is to review the physical activity (PA) intervention research and offer criticisms and future research directions. Laboratory PA interventions have been effective at increasing physical capacity, muscular strength, walking ability, and reducing body weight, stress, depression, and pain. However, laboratory research has been criticized for lacking ecological validity, thus researchers have also investigated whether lifestyle-type community or field-based interventions are effective. Researchers have shown that increasing social support for PA is effective for adults, and water-based activities help children with cerebral palsy increase their functional fitness. Nontraditional approaches such as yoga, massage, relaxation, and mindfulness training might be considered potential antecedents of reduced negative affect, increased positive affect, and enhanced functional fitness.

There are lifestyle strategies that may help preserve cognition in old age and in MCI. While the evidence is still suggestive rather than definitive it is strong enough to make suggestions to patients and families. Cognitive interventions such as computer-based cognitive stimulation and brain fitness programs may be helpful, although more generalized cognitive activities such as taking a college course or learning a new skill may be equally helpful. Aerobic exercise has the best track record to date among lifestyle interventions. Having a variety of leisure activities that combine psychological, physical, and social activities is advised. As far as well can tell, diets that are helpful for preventing heart disease such as the Mediterranean diet also may be good for cognition. The mechanisms for many of these strategies likely involve 1) the brain compensating for circuit loss by engaging new circuits to solve problems and 2) improvements in vascular health.

• Coronary heart disease (CHD) is the leading cause of death and disability in the world• The evidence base for the causes of CHD and for the interventions which reduce CHD risk is huge• Since CHD is multi-factorial, risk factors tend to co-exist in many patients, and are multiplicative in their influence on overall risk, making identifying people at highest risk clinically difficult• CHD risk scores have been developed, based on observed CHD rates amongst well-phenotyped patient cohorts followed up over years. These express absolute risk over a defined period and are the most practical method for determining which people have the most to gain from treatment interventions• Evidence-based interventions include smoking cessation, lifestyle modification in terms of diet and exercise, anti-hypertensives for elevated blood pressure, and ‘statins’ for hyperlipidaemia• Clinical guidelines for CHD prevention provide recommendations on specific targets for blood pressure and lipid-lowering therapy.

Key points• The prevalence of urinary incontinence increases in association with increasing age.• Behavioural and lifestyle interventions, including exercise, are effective in older people.• There is an increasing evidence base for pharmacological therapy of urgency incontinence in the elderly and frail elderly.• Surgical management for older men and women is associated with benefit but should be performed with due regard to potential benefits and harms, remaining life expectancy, and the expectations of both patient and, where relevant, caregiver.• Continence care should be based around provision by specialist nurse practitioners working within a multiprofessional, integrated service.

Secondary prevention through cardiac rehabilitation is the intervention that contributes most to decreasing morbidity and mortality in coronary artery disease, in particular after myocardial infarction but after incorporating cardiac interventions and in chronic stable heart disease. Cardiac patients deserve special attention to restore their quality of life and to maintain or restore their functional capacity and require counselling to avoid recurrence by adherence to a medication plan and adoption of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Components of CR include patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure monitoring, smoking cessation and psychosocial management. This chapter reviews the key components of a CR programme and summarizes current evidence-based best practice for the wide range of patient presentations of interest to the general cardiology community.

Maintaining a healthy weight and engaging in regular physical activity are two health behaviors that can provide significant benefit to individuals with chronic pain. However, adhering to lifestyle programs that promote weight loss and/or physical activity can be challenging. A socioecological model of adherence to healthy lifestyle behaviors in individuals with pain can assist providers in understanding the physiological, intrapersonal/behavioral, and social/environmental factors that influence adherence. Providers can optimize adherence to weight loss by facilitating an effective patient–provider relationship, tailoring intervention approaches to meet a patient’s specific needs, and applying the Five A’s model of behavior change. Providers can support long-term engagement in physical activity by developing patient-centered exercise prescriptions based on an assessment of physical limitations, comorbidities, and age and to engage in shared decision-making to best account for patient preferences and barriers to exercise.

In the UK, the four commonest cancers—lung cancer, breast cancer, colon cancer, and prostate cancer—result in around 62 000 deaths every year. Although deaths from cancer have fallen in the UK over the last 20 years, the UK still suffers from higher cancer death rates than many other countries in Western Europe. In 1999, the UK government produced a White Paper called Saving Lives: Our Healthier Nation that outlined a national target to reduce the death rate from cancer by at least 20% in people under 75 by 2010. The subsequent NHS Cancer Plan of 2000 designed a framework by which to achieve this target through effective prevention, screening, and treatment programmes as well as restructuring and developing new diagnostic and treatment facilities. But do we know enough about the biology of the development of cancer for government health policies alone to force dramatic changes in survival? The science behind the causes of cancer tells us that its origin lies in acquired or inherited genetic abnormalities. Inherited gene mutation syndromes and exposure to environmental mutagens cause cancer, largely through abnormalities in DNA repair mechanisms, leading to uncontrolled cell proliferation. Although screening those thought to be at highest risk, and regulating exposure to environmental carcinogens such as tobacco or ionizing radiation, have reduced, and will continue to reduce, cancer deaths, there are many other environmental factors that have been shown to increase the population risk of cancer. These will be outlined in this chapter. However, the available evidence is largely from retrospective and cross-sectional population-based studies and therefore limits the ability to apply this knowledge to the risk of the individual patient who may been seen in clinic. Although we may be able to put him or her into a high-, intermediate-, or low-risk category, the question ‘will I get cancer, doc?’ is one that we cannot answer with certainty. The NHS Cancer Plan of 2000, designed to reduce cancer deaths in this country and to bring UK treatment results in line with those other countries in Europe, focuses on preventing malignancy as part of its comprehensive cancer management strategy. It highlights that the rich are less likely to develop cancer, and will survive longer if they are diagnosed than those who live in poverty. This may reflect available treatment options, but is more likely to be related to the lifestyle of those with regular work, as they may be more health aware. The Cancer Plan, however, suggests that relieving poverty may be more labour intensive and less rewarding than encouraging positive risk-reducing behaviour in all members of the population. Eating well can reduce the risk of developing many cancers, particularly of the stomach and bowel. The Cancer Plan outlines the ‘Five-a-Day’ programme which was rolled out in 2002 and encouraged people to eat at least five portions of fruit and vegetables per day. Obese people are also at higher risk of cancers, in particular endometrial cancer. A good diet and regular exercise not only reduce obesity but are also independent risk-reducing factors. Alcohol misuse is thought to be a major risk factor in around 3% of all cancers, with the highest risk for cancers of the mouth and throat. As part of the Cancer Plan, the Department of Health promotes physical activity and general health programmes, as well as alcohol and smoking programmes, particularly in deprived areas. Focusing on these healthy lifestyle points can potentially reduce an individual lifetime risk of all cancers. However, our knowledge of the biology of four cancers in particular has led to the development of specific life-saving interventions. Outlined in this chapter are details regarding ongoing prevention strategies for carcinomas of the lung, the breast, the bowel, and the cervix.

Complementary and alternative treatment modalities are commonly used by patients for neuropathy and neuropathic pain due to perceived lack of benefit from conventional medical treatment. As the association between metabolic syndrome and neuropathy is increasingly recognized, diet and lifestyle interventions are becoming important components in the management of neuropathy. Progress in the understanding of the gut–immune interaction highlights the roles that the gut microbiome and inflammation play in the modulation of neuropathy and neuropathic pain. Evidence for nutritional interventions, exercise, supplements, acupuncture, and mindfulness-based practices in the treatment of neuropathic pain is also encouraging. This chapter reviews the available evidence supporting the safe use of complementary and alternative treatments as adjunctive or preferred options to symptomatic treatment with pharmaceuticals in commonly encountered conditions associated with neuropathy and neuropathic pain.

Parkinson’s disease (PD) is the most rapidly increasing neurologic disorder in the world. While the etiology is unproven, interactions between genetic susceptibility, environmental toxins, and lifestyle factors are felt to account for most cases. Although dopamine replacement therapy is a cornerstone of treatment, PD is best managed using a multimodal, individualized, and integrated treatment plan. Physical exercise has been shown to be preventive for the development of PD and beneficial for individuals with PD. Complementary treatment approaches such as the Lee Silverman Voice Treatment–BIG therapy, tai chi, bicycling, and dancing are evidence-based interventions that are of benefit. Acupuncture has been shown to be helpful with nonmotor as well as motor symptoms. Mind/body practices including yoga and meditation have similarly been shown to be beneficial. Nutritional interventions in PD are also important. Several drug–nutrient interactions are important in PD.

Sarcopenia is a progressive and inevitable loss of skeletal muscle mass and strength associated with ageing that places older adults at high risk for adverse health outcomes. Up to of 15% of older adults suffer negative healthcare consequences because of sarcopenia. Furthermore, it is responsible for two to four times greater risk of disability. Expert groups have proposed clinical oriented criteria based on gait speed <0.8 m/s and low handgrip strength before performing muscle mass assessment. Multiple aetiologies are implicated in the development of sarcopenia including age-related, lifestyle, neurodegeneration, hormonal, and inflammation factors. Resistance exercise training and higher than recommended protein intake are two accessible means to counteract sarcopenia. Hormonal interventions, despite amelioration in muscle and fat masses, have not led to significant gains in function. Sarcopenia shares many features with frailty and can be considered as one of its underlying mechanisms.

Cognitive decline with age shows strong interindividual variance. Several epidemiological studies have shown that some of the factors associated with maintaining a good cognitive performance with age are lifestyle factors, such as practising physical activity and being engaged in cognively stimulating activities, which are potentially modifiable even in old age. In parallel, studies in animal models have shown that physical exercise and environmental stimulation result in better cognitive performance, potentiation of neural plasticity, neuroprotection. More recently, intervention studies in humans begin to show that training based on cognitive or physical activity enhance cognitive performance in older adults. At the core of lifestyle effects on cognitive ageing is neural plasticity and the action of multiple molecular factors which translate physical and cognitive activity into adaptive and protective changes in the brain, allowing elders to better face ageing-related cognitive changes.